[Indications for surgical treatment of ulcerative rectocolitis]

The indications to surgical treatment of the ulcerative colitis (RCU) are a discuss argument to date, for etiopathogenetic uncertain still being. The problems of treatment are expressed by A.G. Parks and J.H. Pemberton very well, who said that "... Its treatment, both medical or surgical, is empirical", and "... The patients with chronic ulcerative colitis heal with proctocolectomy". From 1980 to 1992 we observed 65 cases of URC. 21 (32%) of these were treated by surgery. The indications to surgical treatment were: unsuccessful of medical therapy (14 cases), toxic megacolon (3 cases), severe dysplasia (2 cases), perforation (2 cases). We have submitted 5 patients to colectomy with ileostomy, 13 patients to colectomy with ileorecto-anastomosis and 3 to proctocolectomy with definitive ileostomy. Morbidity was 14.2% (anastomotic linkage, bronchopneumonia sepsis, wound sepsis). Mortality was 4.7% for a case of large bowel multiple perforations. The treatment of the URC is a difficult choice for surgeon, because he must decide the surgery timing. To different of the Crohn's disease, that is not heal with surgery, today URC allows more surgical aggressive attitude.